Diagnosisofliverfibrosisinpatientswithheartfailure

Aim

To assess the dynamic changes in liver stiffness measurements and direct fibrosis markers in patients hospitalized with acute decompensated heart failure (ADHF) receiving standard heart failure therapy according to the international guidelines.

Material and methods

We recruited 35 patients (8 female, age 66.0±11.6 years) with ADHF (NYHA III-IV class). The duration of chronic heart failure ranged from 0.4 to 13.0 (6.2 ± 2.8) years, the average ejection fraction (EF) of left ventricle was 35.8 ± 12.9%. Transient elastometry measurements (FibroScan®) and direct markers of fibrosis were analyzed at baseline and at discharge from the hospital.

Results

Liver stiffness decreased significantly after treatment for heart failure (from 26,3 [19-48] to 16.6 [1121.8] kPa; p<0.01). However, it remained elevated (grade 4 METAVIR score). A decline in liver stiffness significantly correlated with weight loss (р<0.05) and reduction of edema (р<0.05). Direct markers of fibrosis were elevated at admission to the hospital and did not change significantly during hospitalization.

Conclusion

Increased liver stiffness in patients with ADHF cannot be explained only by fibrosis, and tends to be overestimated due to the presence of congestion. Therefore, transient elastometry has limited utility for assessment of fibrosis in patients with ADHF.